HomeMy WebLinkAboutBLD2014-00392 - MECHANICAL , JILDING PERMIT APPLICAT N BLD14-00392
Review Type:
Jefferson County Department of Community De a opment
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-00392 Received Date: 10/23/2014
SITE ADDRESS: 193 MAXVIEW DR
PORT LUDLOW, 98365
OWNER: PETER C ALEXANDER PHONE: 360-437-4091
CELESTE E ALEXANDER
193 MAXVIEW DR
PORT LUDLOW WA 98365-9577
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 721093024 Section: 9 Township: 27 N Range: 1 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION INSTALL A NEW GAS FIREPLACE WITH ABOVE GROUND TANK AND
PIPING
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION ADD'L: HEAT TYPE: PRO
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
IRouting Date:
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $228.00 SRE 10/21/14 151666
Total: $228.00 i't1 - �, R oV ED
OCT L 3 2014
Je fe r-.cn County DCD
Q:r t- m Our 1/3. /(4
\\tidemark\data\forms\F_BLD_App_Bld.rpt 10/23/2014
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k� c JEFRSON COUNTY
H„ a
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.us/communitydevelopment
16'1-/1 Nc'�o Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd(aco.iefferson.wa.us
Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
/n all new qc2. rep/ace wifh new above c'round funk and piping,
Tax Parcel Number: Property Size: 3•ZZ ' (acres/square feet)
Site Address and/or Directions to Property: /"7Axv Lud/ow I/A c
Property Owner(s)of Record: and A/ xand -r
Telephone: /Fax: email: pca/exI300�
Mailing Address: I"3 /'7 ax–/ w I-•, /1='or/ Lud/ow. VW ft gr�ai/,core
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
❑Building ❑Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]-*
❑ Manufactured Home ❑ Modular ❑Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use ❑Boundary Line Adjustment
❑ Address ❑Road Approach ❑Short Plat**
❑Home Business ❑Cottage Industry ❑Binding Site Plan**
.r Propane ❑Long Plat**
❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration**
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development**
❑Temporary Use ❑Shoreline Management Variance
El Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre–Application Conference ❑Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorneys fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any r- .ired later inspections. Staff's access and ri.ht of entry will be ass ed unless the applicant informs the County in writing at the
time of the a. .r en ► e or a wants p r n• • e.
Signature: . / �. Jr- � "Y Date: /o 101
The action or actions Applicant will unde ake as a result of the issuance of this permit may negatively impact u on one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if ..are in c• pliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-trap *In ity •r.' enng to an.coy.plyin ith re E The;.plican as read this disclai ran s and dates it below.
Signature: � �_ _ i%;i i C Date: /011 /
07/24/2013
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4 ' '` BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owne .f t .-rcel referenced herein,that they are not licensed contractors and that
they will be as�tf g th espon ibility oft e G e/ o -act.r .r a prop.- d project.
Signature:vfri���_ . _ _t / /�, `I:te: /D /7 !�
GENERAL CONTRACTOR OR MANUF,CTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New !d Wood Existing: 2 ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
X Alteration/Remodel ❑ Concrete Total: Z Height: Wr Individual System
❑ Repair ❑ Masonry SEP Permit# n -nn?S9
Li Demolition ❑ Other: Bedrooms: Water Supply:
Existing: 3 Setback: ❑ Private well Two Party
Type of Heat: Proposed: a Public
/-7ecn` pump Total: - Name of System:
L ,rir/cy /?rave-ri
If this is a Commercial Proiect you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
Underground Tank ove ground tan Size of Propane Tank: /.20 mac,/
Heat Stove Cook Stove Woodstove ireplace)nsert rehtO 1 evotS telleP 1 knaT retaW toH I
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
r-: ;
Square Footage Current Proposed uF c,Office Use Only z,„.„; „� Amount Revision
Main Floor Heated ,,- 4 ,^,q,• EH Bld App Review:
2nd Floor Heated o VA-i Consistency Review:
Other Heated Base fee: v
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee: i
9C t
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other
TOTAL: $;4J7 CID
e
Receipt Number: / 5/ &r6/67
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: ro n r
.Fair market valve of all labor and materials foundation to finish / ;P
"70°61 Initials:
/V
07/24/2013
Parcel Print Page 1 of 1
Parcel Number.721093024 08/15/2014
Owner Mailing Address:
PETER C ALEXANDER
CELESTE E ALEXANDER
193 MAXVIEW DR
PORT LUDLOW WA 98365-9577
Site Address:
193 MAXVIEW DR
PORT LUDLOW 98365-9577
Section: 9 School District: Chimacum(49)
Qtr Section: SW1/4 Fire Dist: Port Ludlow(3)
Township: 27N Tax Status: Taxable
Range: 1E Tax Code: 0231
Planning area: 98365-9577
Sub Division:
Land Use Code: 1100
98365-9577
Property Description:
COYLE PENINSULA PROPERTIES SP I LOT 1
http://www.co.jefferson.wa.us/assessors/parcel/parcelprint.asp?PARCEL NO=721093024 10/23/2014
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=7, �°�, JEFFERSON COUNTY .
.m. DEPARTMENT OF COMMUNITY DEVELOPMENT
Date: M '3QTime Received: 337 a Mon Tue. Wed. Thur. Fri.
Date: \jAA.f T
BLD: /1/-- 92.- Contact Name:
Owner: Contact Number: 3607 'f
Address: /93 1/141X e Dr 206
Notes:
Foundation Plumbing Framing Propane Tank Mechanical
Setbacks Under-ground Framing Under ground Furance
Footing Rough In Air Seal Above ground 'K Gas
Stemwall Hydronic Exterior shear Exterior lines Oil
Straps Hot Water Htr Interior shear Interior lines Ducts
Post Hole Ventilation Appliance
Underfloor Gas/Wood stove
Man-Homes Insulation
Final Inspection
- Setbacks Floor
Foundation Wall Address Posted
Block&Tile Ceiling
FMS°N, co. +
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JEFFERSON COUNTY j4L. �DEPARTMENT OF COMMUNITY DEVELOPMENT
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abe-i lite°4
Date: 1 Time Received: 2 Z a �� Mon Tue. Wed. V `Fhur. Fri'.
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Date: 12 _3
BLD: II--- 5472_ Contact Name:
Owner: Contact Number: 360 3 7 y097
Address: t q 73 ,,,4--1 if, pc 206
Notes:
Foundation Plumbing Framing Propane Tank Mechanical
Setbacks Under-ground Framing V., Under ground Furance
Footing Rough In Air Seal �. Above ground Gas
Stemwall Hydronic Exterior shear Exterior lines Oil
Straps Hot Water Htr Interior shear Interior lines Ducts
Post Hole Ventilation Appliance
Underfloor Gas/Wood stove
Man-Homes Insulation
Final Inspection
Setbacks Floor
Foundation Wall Address Posted
Block&Tile Ceiling
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MECHANICAL AND DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD14-00392 Received Date 10/23/2014
SITE ADDRESS: 193 MAXVIEW DR Issue Date 10/23/2014
PORT LUDLOW, 98365
APPLICANT: PETER C ALEXANDER PHONE: 360-437-4091
CELESTE E ALEXANDER
193 MAXVIEW DR
PORT LUDLOW WA 98365-9577
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 721093024 Section: 9 Township: 27N Range: 1E
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, PETER C ALEXANDER PHONE: 360-437-4091
if different: CELESTE E ALEXANDER
193 MAXVIEW DR
PORT LUDLOW WA 98365-9577
PROJECT DESCRIPTION: INSTALL A NEW GAS FIREPLACE WITH ABOVE GROUND TANK
Directions AND PIPING
To Site:
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 10/23/2015.
REQUIRED INSPECTIONS:
Installation per Manufacturer Specifications/CO2: /'R J.1 fri/ / 4/E S en Fkb pi W E-
L to115 vK /2/R/11.
Tank/Line/Appliance: its f 2-/*//L/
Final Approval: Ti2G pp Nl� 5 OW,' Utz=/% V 414/L--
BUILDING INSPECTION HOT-LINE 379-4455.
REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED.
Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday
HOT LINE AVAILABLE 24 HOURS A DAY
\\tidemark\data\forms\F_BLD_Permit_Propane.rpt 10/23/2014